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ACADEMIC SERVICES

Student-Athlete Tutorial Program
Successful Students use Tutoring

Tutor Request Form

You will be notified by email when your appointment has been scheduled.

Date:

Student Information
Student Name:
Sport:
Email Address:
Phone:
Course Information
Course Name & No. (ex. UGC111):
Course Instructor:
Class Meets:
Do you attend class regularly? Yes No
If no, please state why:    
I need to meet with a tutor:
2-3 times per week
to review for tests only 		once a week
1 time only 		 
Additional Comments:
Statement of Understanding
I understand that, by being assigned a tutor for the course(s) requested, I am agreeing to meet with the tutor on an agreed upon schedule or as determined by my academic advisor. I have been advised of my responsibilities and I understand that failure to meet with the tutor can lead to the discontinuation of my tutoring services.
I Agree

ACADEMIC SERVICES
 •  Academic Services
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 •  Tutoring
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CONTACT INFORMATION
 •  Location: 169 Alumni Arena
 •  E-Mail:
ath-tutoring@buffalo.edu
 •  Phone: 716-645-5533
 •  Mailing Address:
University at Buffalo
Division of Athletics
169 Alumni Arena
Buffalo, NY 14260

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